A young woman’s face appeared on a video call one day last month. Her eye was injured. And, she said, her head and neck were also injured – after being hit by a baton.
She’s 21 years old and was too afraid to visit a hospital.
Her injuries, after all, were the result of marching for women’s rights on the streets of Iran. The young woman, whose name was not disclosed to protect her anonymity, is one of thousands of Iranian protesters who have taken to the streets since the death of Mahsa Amini at the hands of the theocratic nation’s morality police.
Fearing a hospital would report her to the authorities, the young woman with the eye, head and neck injuries saw her doctors virtually. For the next 10 days, she received physical and mental health services from doctors who speak Farsi and understand her culture – but live in Southern California.
Those doctors are brothers Kamiar and Arash Alaei, Iranian natives who are also professors at Cal State Long Beach. The brothers have responded to the protests in their homeland – about 7,700 miles from Southern California – by offering virtual medical assistance to those fighting for greater freedoms.
But it’s not just them.
The Alaei brothers have created a coalition of medical professionals called the Medical Alliance for Health Services Abroad, or MAHSA – in honor of Mahsa Amini. The coalition has more than 120 active members, offering free telemedicine services at least 16 hours a day to help manage the time differences between Iran and other parts of the world.
Such care is vital because, the Alaei brothers said in recent interviews, visiting local hospitals and clinics can get Iranian protesters arrested.
“It’s definitely crucial how we can help people inside Iran,” said Kamiar Alaei, who is the chair of CSULB’s health science department, “and I think everybody can help in any capacity to be the voice of the voiceless.”
The MAHSA coalition’s mission is to help those fighting against a government that, according to human rights organizations, lacks the types of freedoms Americans enjoy and sometimes take for granted. In that way, the coalition’s work also illustrates the way technology can increase access to health care globally.
“We often talk about digital health as a broader group of services that can be provided through technology,” said Dr. Adam Solomon, chief medical officer for the MemorialCare Medical Foundation.
“Telemedicine would be a subset of that,” Solomon added, “because typically when someone thinks of telemedicine it is the ability to see and be evaluated by a clinician through either a video visit or potentially a phone visit.”
And for the Alaei brothers specifically, offering telehealth services to Iranian protesters represents their own form of resistance.
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The Alaei brothers are expats – or, perhaps more accurately, exiles.
They grew up in Kermanshah, a city about 325 miles west of Tehran that now boasts a population of nearly 1 million people.
They learned lessons about helping others from their father, Shaban.
And as children, they saw teens and young adults go to school, apply to universities, graduate – and they return to help their community.
But that was before the Iranian Revolution of 1979, when a theocratic regime took over and isolated the culturally vibrant country from much of the world.
Arash Alaei, who is now 53, was about 10 when the shah was exiled and the Iranian Republic took hold. Kamiar Alaei, now 48, was around 5.
But the takeover didn’t stop the brothers from being inspired by their compatriots – or from being motivated by the societal ills they saw.
During their formative years, in the 1980s, they witnessed how doctors helped people during the war between Iraq and Iran.
The discrimination they witnessed, including against those with HIV/AIDS, further motivated the brothers to go to medical school and become doctors.
Today, the smell of the seasons in Kermanshah remains an indelible memory of home for the elder Alaei brother. But the needs of his fellow Iranians, which inspired both brothers to want to do more, remains an equally indelible, though far less fond, memory.
Kamiar and Arash Alaei both graduated from medical school in their late 20s.
Then, in the 2000s, the Alaei brothers established the first comprehensive “triangular clinic” for three target groups in Iran – drug users, HIV/AIDS patients and those with other sexually transmitted diseases.
They established the clinic during a time when those groups were being specifically targeted by governments in the Middle East, North Africa and Central Asia. (In many places, such targeting continues.) Kamiar and Arash Alaei had to learn to navigate the challenges of providing health care to people the Iranian government tried to oppress, they said.
Alcohol and drug use are illegal in Iran, as is homosexuality, and punishments are frequently severe, including long prison sentences and execution, according to the U.S. State Department.
That stigma and illegality, as health experts have frequently said about anti-LGBTQ laws in the U.S., often prevent people from seeking medical attention.
The Alaei brothers’ work via their clinic was so important, the elder sibling said, that the World Health Organization documented it as a “best practice model.”
“We tried to engage communities and identify some of the more open-minded leaders in the community,” Kamiar Alaei said, “and find our shared values – that is, saving somebody’s life.”
But the brothers eventually drew the attention of the Iranian government.
In June 2008, the brothers were detained in Tehran’s Evin Prison, they said. They were accused of being involved in a conspiracy to overthrow the Iranian government because of their work with the clinic.
The younger Alaei brother stayed in prison for more than two years, until December 2010 – while Arash Alaei wasn’t released until August 2011.
“We didn’t know what was going on outside,” Arash Alaei said, “but when we had an opportunity to talk to our parents, we found thousands of American and European people had sent letters to our parents to say, ‘We are with you.’”
The brothers were expelled from Iran – and aren’t allowed back.
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We try to be advocates whenever there is a need.
– Kamiar Alaei
Their experiences in Iran, though, provide the brothers with particular insight into the dangers protesters there face.
Iran has dealt with sporadic anti-government protests since the 1979 coup. But they have typically been put down swiftly and harshly.
The current protests, however, have not been easy to extinguish.
Iranians began taking to the streets by the thousands after the Sept. 16 death of Amini, a 22-year-old woman who was initially detained by the country’s morality police, which accused her of wearing her headscarf too loosely, according to a United Nations statement. She died while in the hospital.
Her family and protesters say her body showed bruises and other signs of beating after she was detained. Iran’s government insists Amini was not mistreated.
The protesters, meanwhile, have faced a bloody response from the government. Hundreds have been killed. And others have been sentenced to long prison terms or execution in “sham trials,” the State Department said in a Wednesday, Dec. 21, press release in which the agency announced sanctions against Iran.
“The Iranian regime has responded with ruthless crackdowns on peaceful protesters in an effort to suppress the Iranian people’s voices,” the press release from Secretary of State Anthony Blinken’s office said. “Iranian authorities have killed hundreds of peaceful protesters, including dozens of children, and arbitrarily detained thousands.”
The force the authorities have used against the protesters didn’t surprise the Alaei brothers. But they knew they had to help, so they started working to provide telemedicine from afar.
“We try to be advocates whenever there is a need,” Kamiar Alaei said.
They mobilized other doctors to help provide telemedicine to protesters, and received help from Physicians for Human Rights and other organizations.
Protesters have been shot and beaten, Arash Alaei said, and “a number of people report tear gas and different harms against people in the streets.”
Iranian demonstrators are afraid to go to local hospitals and clinics when injured, added Arash Alaei, who is also the director of the Institute for International Health and Education, a global nonprofit that designs and implements international education strategies and program services.
And rightfully so. That’s because if they look for medical assistance, the institutions are required to report to the Iranian government, he said.
“There are some doctors in Iran that try to provide some medical support,” Kamiar Alaei said, “but still, there is a general fear.”
Protesters, then, must seek help from those in other countries – via telemedicine.
Offering that service is a way for the brothers to help their compatriots and those in other Middle Eastern countries – even while unable to return to their native Iran.
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Recently, the Alaei brothers encountered – virtually, of course – a 28-year-old man who had been shot in the eye with a rubber bullet.
An ophthalmologist with MAHSA helped the man figure out whether he needed major surgery. But getting surgery, if necessary, wouldn’t be easy.
Luckily, MAHSA helps with that too.
MAHSA, in some ways, acts like a medical underground railroad, providing protesters with local hospitals and doctors that are safe for them to visit when necessary.
The doctors inside Iran, Arash Alaei said, are taking a risk if they try to help protesters. Some are arrested and banned from hospitals, he said.
And so, Kamiar Alaei said, doctors elsewhere must also advocate for Iranian physicians. The Alaei brothers, in fact, have a petition to bring awareness of the challenges Iranian doctors face to the United Nations. The petition currently has 60 doctor signatures and nearly 4,000 other signatures, as of Friday afternoon, Dec. 23.
But working directly with patients is the brothers’ primary mission – a mission made possible because of technology.
As such, MAHSA’s operations are also instructive. Telemedicine, after all, isn’t necessary only in the context of uprisings against oppressive regimes.
Rural parts of the United States, for example, may not have as easy access to subspecialists – such as a pediatric cardiologist or a hematologist – as urban areas, said Solomon, the doctor with the MemorialCare Medical Foundation.
But with these virtual tools, it’s easier to provide health care access broadly throughout a state, Solomon said.
“Potentially, this can also provide that support and service to other, poorer countries,” he added. “The big hurdle there would be the technology to have access to broadband services, which even in this country is (not assured).”
But at least in the U.S., there’s no fear that the government will track down those who receive virtual medical attention.
That’s not the case in Iran.
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In past decades, there wasn’t much expat doctors could do to help their fellow Iranians.
But that’s not true today.
“Doctors used to travel to different countries, but now we can do it remotely,” Arash Alaei said. “That’s the beauty of telemedicine.”
Beyond diagnosing folks, doctors can use virtual health care to share educational material or basic medical information with protesters, including how to protect themselves and minimize injuries.
There were challenges, however, including getting the word out and helping protesters while ensuring their safety.
The brothers solved the first problem by putting out an ad on Iranian satellite television and on their social media pages explaining what they do and how to reach them for help. To be able to connect and build trust with future patients, they also started making videos to show who was behind the virtual help.
As a result, the brothers said, messages started flooding in.
But there’s a risk in helping people.
“The internet speed is not high,” Arash Alaei said, “and the government controls the internet.”
For now, the brothers have a designated cell phone they use for calls and video consultations.
But they are unsure how long that will last. So Arash Alaei is asking people that work in technology to find a solution and is looking for a way to get a toll-free number.
Then there’s the need to protect patients’ identities.
One way MAHSA doctors do so is by not asking too many questions.
They do ask about a person’s mental health and any immediate injuries that should get checked out.
But mostly, they listen. They let demonstrators share their challenges, Arash Alaei said – because that’s the best way to learn about their specific situations and needs.
“We don’t want to put them in any challenging situations,” Arash Alaei said, “so we don’t ask about their name and address. We don’t want to identify them, to assure them they are in a safe environment.”
The most common injuries the brothers see, they said, are to the eyes, lips, head, neck and shoulders.
“It’s not just one visit,” Arash Alaei said.
Rather, each case includes a series of visits from the Alaei brothers or one of the 100 other doctors and specialists that help with the one-on-one consultations.
The brothers, though, also said Iranians need more help from the global community.
“We are happy to have this opportunity but it’s not enough to have a group of people,” Arash Alaei said. “We need to have global action to provide services and use telemedicine as a platform to increase access for everyone around the world to high-quality services.”
And, the brothers said, the need for virtual medicine in Iran will likely continue long after the protests end – no matter the outcome.
For now, however, the CSULB professors will keep doing what they can.
They will listen as a 21-year-old woman describes her injuries from a baton. They will advise a 28-year-old man who was hit in the eye with a rubber bullet.
They will help any other protester who comes to them.
That’s because even as exiles, they are with their fellow Iranians – who are fighting for freedom 7,700 miles away.
